Cardioversion: a reset button?

Just returned from my EP appt and my Dr suggested I get an electrical cardioversion. He said its like a computer reset for the heart and once converted, I should start taking something like rythmol to keep it in NSR.
This doesn't seem to make much sense to me. I would just assume that I would go out of rythm within a day or so anyway. Things have gotten worse for me. I'm usually in afib for like 5 out of 7 days a week.
Has anyone had a cardioversion and has it helped them stay in NSR for an extended period of time?
I told him I'ld think about it and he left it open so I can call and schedule an appt.

I also asked him what he did with my ablations. He said standard PVI and and any strays that showed up when I was put in afib. He says that he doesnt think my afib is coming from my pulminaries. He basically said I'ld have to live with it except to try a cardioversion to stay in NSR longer and prolong permanent afib.

Or worse, the cardioversion won’t do anything at all and you’ll still be in AF. You can try it but it is by no means guaranteed to either work at all or hold very long.

You need a new EP, I think.

Are you not on antirhythmic drug's right now?
It's possible if you started on an antirhythmic you would convert on your own.
I was cardioverted once just before starting a new drug as the one I was on was no longer working and I had been out if rhythm with a high rate for over a week. I stayed in rhythm about 3 days. I was then started on a new drug and converted in several hours.
I would also seek out a new EP.

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Billyjeans
I also asked him what he did with my ablations. He said standard PVI and and any strays that showed up when I was put in afib. He says that he doesnt think my afib is coming from my pulminaries. He basically said I'ld have to live with it except to try a cardioversion to stay in NSR longer and prolong permanent afib.

You need a new EP. He's out of his league.

14 years ago my EP said he could cardiovert me, but the hard question was how to keep me in rhythm afterward. He didn't have a good one, but i suggested cardoversion followed by me trying to stay in rhythm with electrolytes and him writing me a prescription for flecainide on-demand (PIP) for me to use to convert when the electrolytes failed. He agreed, I used flec to convert the 2.5 month episode I was in and have been following my plan since.

I had 3 cardioversions over the space of 18 months.. First one lasted 36 hours, second didn’t work at all, third, with anti-arrhythmic drugs, lasted 48 hours. I then went for ablation with one of the world's best in Bordeaux, still working after 15 years.

Gill

If your going into NSR on your own, then you need to try somehow to maintain the NSR. Sounds like you should just start taking an Anti-Arrythmic like the Rythmol, and then the next time you convert into NSR, maybe you can maintain it.
Cardioversions are for people that cannot or are very unlikely to convert out of AFIB on their own. I have had many ECV's, ordered my different Dr's, and nobody ever said that getting an ECV is somehow better than spontaneously self-conversion. I have never heard of such a thing, and if anyone reading this has heard of such a concept, please respond.
The other issue, is that there are more risks involved in getting an EVC, than converting on your own. The time lost in the Hospital, Adverse effects from Anesthesia, and increased Stroke risk is associated with ECV's. The blast to the Heart is more likely to dislodge a Clot that is attached to the Wall of the Heart. Also the electric shock goes up through the Neck and Head, subjecting the Brain to a massive jolt. It sounds like your Dr. may have not understood that you are spontaneously converting on your own? I admit I have noticed less Ectopy for about a week following my ECV's, but this is certainly not even close to making sense to endure a massive electrical blast to the Heart and Head, when I could just wait several days and convert on my own.

Anti-Fib... Long ago, when I began my Afib journey, the rule was then, if you weren't on an anticoagulant... (and then there was only warfarin)... and the duration of your Afib event lasted 48 hours, you should have an ECV... and to plan ahead so that it was done before the 48 hours was up... thus, the "48-hour rule." That was because the ongoing duration in fibrillation was more likely to contribute to clot formation the longer the heart was in arrhythmia.

The risk of clot formation in the heart from stagnant blood... churning and not being pumped out efficiently is still a bonafide factor. For that reason, and because I didn't get along with warfarin and stopped using it, I learned about the sticky, thick blood and risk of clots... even without the complication of Afib. Thus, all those posts on Clot Risk and the important tests that determine the various factors that cause blood to clot more easily... esp. in AF... such as inflammation... measured by CRP, fibrinogen, triglycerides, etc. Since I couldn't use warfarin, I relied on regular use of nattokinase and that kept me safe even if I sometimes went longer than 48 hours before the ECV.

If one is on a prescription anticoagulant, undoubtedly, the risk of clot formation is far less. However, 11 years after my first ablation, I began having a-flutter events and was told to go for the ECV's which I did. It's difficult to function in flutter with heart rates around 200 bpm. But, I do agree that going to an ER or Urgent Care facility is a toss up as to whether one can get help or not. Fortunately, I had access to an arrhythmia center in a nearby hospital that helped me get in for cardioversions usually with half a day's notice and until I had the 2nd Natale ablation, I made many trips thanks to the EP in charge there.

After the last ablation in 2015, I needed a local contact for Eliquis prescription renewals and that EP affiliated with a local branch of the CCF told me that he was available for ECV should the need arise.

I agree with you about the blast of the shock and fortunately, my brain managed to overcome all those insults... and there were many.

Jackie

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The Anti-Fib
If your going into NSR on your own, then you need to try somehow to maintain the NSR. Sounds like you should just start taking an Anti-Arrythmic like the Rythmol, and then the next time you convert into NSR, maybe you can maintain it.
Cardioversions are for people that cannot or are very unlikely to convert out of AFIB on their own. I have had many ECV's, ordered my different Dr's, and nobody ever said that getting an ECV is somehow better than spontaneously self-conversion. I have never heard of such a thing, and if anyone reading this has heard of such a concept, please respond.
The other issue, is that there are more risks involved in getting an EVC, than converting on your own. The time lost in the Hospital, Adverse effects from Anesthesia, and increased Stroke risk is associated with ECV's. The blast to the Heart is more likely to dislodge a Clot that is attached to the Wall of the Heart. Also the electric shock goes up through the Neck and Head, subjecting the Brain to a massive jolt. It sounds like your Dr. may have not understood that you are spontaneously converting on your own? I admit I have noticed less Ectopy for about a week following my ECV's, but this is certainly not even close to making sense to endure a massive electrical blast to the Heart and Head, when I could just wait several days and convert on my own.

I have had many ECV's, ordered my different Dr's, and nobody ever said that getting an ECV is somehow better than spontaneously self-conversion. I have never heard of such a thing, and if anyone reading this has heard of such a concept, please respond.-----------

Well this is what hes claiming. I always convert. Granted it can take up to 4 days or so but I always convert and he knows that.
I have tried pretty much all of the anti arrythmic drugs and they all have made my afib worse. He knows that too. I just think he doesn't know what to do anymore and thats why hes suggesting something like an ECV.

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rocketritch
Are you not on antirhythmic drug's right now?
It's possible if you started on an antirhythmic you would convert on your own.
I was cardioverted once just before starting a new drug as the one I was on was no longer working and I had been out if rhythm with a high rate for over a week. I stayed in rhythm about 3 days. I was then started on a new drug and converted in several hours.
I would also seek out a new EP.

I believe I've tried most of the antirhythmic drugs out there and they only made things worse. Just curious, which one worked for you?

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Carey

I also asked him what he did with my ablations. He said standard PVI and and any strays that showed up when I was put in afib. He says that he doesnt think my afib is coming from my pulminaries. He basically said I'ld have to live with it except to try a cardioversion to stay in NSR longer and prolong permanent afib.

You need a new EP. He's out of his league.

No doubt.. I cant get one tho.

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Billyjeans

Are you not on antirhythmic drug's right now?
It's possible if you started on an antirhythmic you would convert on your own.
I was cardioverted once just before starting a new drug as the one I was on was no longer working and I had been out if rhythm with a high rate for over a week. I stayed in rhythm about 3 days. I was then started on a new drug and converted in several hours.
I would also seek out a new EP.

I believe I've tried most of the antirhythmic drugs out there and they only made things worse. Just curious, which one worked for you?

I was started on flecanide and metaprolol in the hospital after that initial episode following my first ablation. Then years later when I would get the occasional attack, I used the flecanide as a PIP. Until it stopped working for me.
I am currently taking Ticosyn, since my failed ablation in January, which kind of works. I have my third ablation scheduled for next week with Dr Natale in Texas.
I would definitely be seeking out a new EP. My current EP admitted to me that he had done all he felt he could do for me. We had a long discussion about further options and his recommendation was to possibly have a laproscopic ablation. I mentioned to him that I was pursuing and ablation with Dr Natale and he said that if he was willing to take my case that I should by all means see him. He also offered to do anything he could to help move the process along.
He also offered to remain my EP locally for any follow up visits or tests I may need.
A good doctor should be vested in the best outcome for your health regardless of weather or not they are able to help you themselves. Not only did he speak these words to me but one of his fellows reiterated the same statement to me as well.



Edited 1 time(s). Last edit at 07/12/2018 07:27PM by rocketritch.

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Billyjeans
No doubt.. I cant get one tho.

Why not?

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rocketritch


Are you not on antirhythmic drug's right now?
It's possible if you started on an antirhythmic you would convert on your own.
I was cardioverted once just before starting a new drug as the one I was on was no longer working and I had been out if rhythm with a high rate for over a week. I stayed in rhythm about 3 days. I was then started on a new drug and converted in several hours.
I would also seek out a new EP.

I believe I've tried most of the antirhythmic drugs out there and they only made things worse. Just curious, which one worked for you?

I was started on flecanide and metaprolol in the hospital after that initial episode following my first ablation. Then years later when I would get the occasional attack, I used the flecanide as a PIP. Until it stopped working for me.
I am currently taking Ticosyn, since my failed ablation in January, which kind of works. I have my third ablation scheduled for next week with Dr Natale in Texas.
I would definitely be seeking out a new EP. My current EP admitted to me that he had done all he felt he could do for me. We had a long discussion about further options and his recommendation was to possibly have a laproscopic ablation. I mentioned to him that I was pursuing and ablation with Dr Natale and he said that if he was willing to take my case that I should by all means see him. He also offered to do anything he could to help move the process along.
He also offered to remain my EP locally for any follow up visits or tests I may need.
A good doctor should be vested in the best outcome for your health regardless of weather or not they are able to help you themselves. Not only did he speak these words to me but one of his fellows reiterated the same statement to me as well.

Ah.. ticosyn, thats probably the only one I haven't tried. Maybe next time I'll ask my Dr for it and give it a shot.
Your EP sounds alot like mine in that they've realized their limitations. I think thats a good quality to have. If you dont think you can do it successfully than dont try. Let someone with more experience do it. I wish you the best with Natale. I hope to get to him some day myself.

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Carey

No doubt.. I cant get one tho.

Why not?

I have no insurance. I'm dealing with the dept of health and they are very limited in what they can do for you. They contract one office and thats it.
As it stands now, they are basically done with me. We've reached a dead end.

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rocketritch

I mentioned to him that I was pursuing and ablation with Dr Natale and he said that if he was willing to take my case that I should by all means see him. He also offered to do anything he could to help move the process along.

He also offered to remain my EP locally for any follow up visits or tests I may need.
A good doctor should be vested in the best outcome for your health regardless of weather or not they are able to help you themselves. Not only did he speak these words to me but one of his fellows reiterated the same statement to me as well.

Now that is an awesome doc who has your best interests at heart!!

My local EP had the same attitude. He actually said he was relieved I had decided to go to Natale because he wasn't confident of doing another ablation on me. He had my records in Natale's hands the next day, and I made sure Natale's office copied him on everything. He has continued as my local EP for followup purposes. His positive reaction and professionalism earned him a patient for life.

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GeorgeN


I mentioned to him that I was pursuing and ablation with Dr Natale and he said that if he was willing to take my case that I should by all means see him. He also offered to do anything he could to help move the process along.

He also offered to remain my EP locally for any follow up visits or tests I may need.
A good doctor should be vested in the best outcome for your health regardless of weather or not they are able to help you themselves. Not only did he speak these words to me but one of his fellows reiterated the same statement to me as well.

Now that is an awesome doc who has your best interests at heart!!

We have develped a very good relationship over the years. He actually has called me personally over the years to discuss different things concerning my condition. Especially folowing my last abaltion with him back in January. He also has asked for me to have notes from my ablation with Natale sent to him as well.

My cardiologist is the same way. Guess that happens when you deal with someone for over 20 years. I went through several cardiologists before I found him. Unfortunately he is retiring and I will one day need to seak out another.